title: Acalculous cholecystitis in severely burned patients: incidence and predisposing factors.
abstract: OBJECTIVE
  To investigate the incidence and predisposing factors of acalculous cholecystitis (AAC) in severely burned patients.
  
  
  BACKGROUND
  Although some studies report on AAC in critically ill patients, very little is known about AAC after severe burns.
  
  
  METHODS
  We conducted a retrospective cohort study involving patients with burns admitted to the burn intensive care unit (BICU) of a university hospital. The patient cohort was divided into two groups (AAC group: burned patients with histological proven acalculous cholecystitis, n=15;
  
  
  METHODS
  population of all other burned patients admitted to the BICU, n=1225). Univariate and multivariate analyses were used to identify predisposing factors for the development of AAC.
  
  
  RESULTS
  Fifteen patients with acalculous cholecystitis were identified in the study period. This represents 1.2% of all significant burns admitted. Comparing the AAC group with the Control population the following patients' characteristics, therapeutic measures and outcome parameters were significantly different in the univariate analysis: mean age (54.0 years vs. 42.0 years), BMI (28.9 kg/m(2) vs. 25.6 kg/m(2)), abbreviated burn severity index (8.3 vs. 6.4), total body surface area burn deep partial thickness (12.0% vs. 6.2%) and full thickness (10.2% vs. 6.8%), concomitant inhalation injury (80.0% vs. 28.9%), sepsis (46.7% vs. 14.9%), catecholamine (100% vs. 30.4%) and antibiotic requirement (100% vs. 58.2%), non-biliary tract operations (4.9 vs. 1.5), BICU length of stay (63.4 days vs. 21.0 days), ventilator days (50.3 vs. 11.9), packed red blood cells (PRBCs) administration (70.0 units vs.13.0 units) and mortality (53.3% vs. 19.7%). In the multivariate analysis however, only age, the number of administered units of PRBCs and the duration of mechanical ventilation turned out to be independent predictors for the occurrence of AAC.
  
  
  CONCLUSIONS
  AAC is a rare complication of severely burned patients and may reflect the severity of the patient's general conditions. Predisposing factors for AAC are advanced age, the need of blood transfusions and prolonged mechanical ventilation. In the presence of these predisposing factors, early monitoring may help to detect AAC earlier and to initiate appropriate intervention.
authors.affiliation: Department of Plastic and Reconstructive Surgery, University of Witten-Herdecke, Cologne City Hospitals Merheim, Cologne, Germany. Panos_Theodorou@yahoo.de
authors.forename: P
authors.initials: P
authors.lastname: Theodorou
authors.forename: C A
authors.initials: CA
authors.lastname: Maurer
authors.forename: T A
authors.initials: TA
authors.lastname: Spanholtz
authors.forename: T Q V
authors.initials: TQ
authors.lastname: Phan
authors.forename: P
authors.initials: P
authors.lastname: Amini
authors.forename: W
authors.initials: W
authors.lastname: Perbix
authors.forename: M
authors.initials: M
authors.lastname: Maegele
authors.forename: R
authors.initials: R
authors.lastname: Lefering
authors.forename: G
authors.initials: G
authors.lastname: Spilker
mesh_terms: D042101:Acalculous Cholecystitis / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D000328:Adult; D002056:Burns / Q000150:complications*; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged